Patients with depression treated in two independent health care systems experienced
overall drops in suicide attempts between the month prior to starting treatment
with antidepressant medications and the month after treatment began.

The findings are based on records from a large prepaid health plan and from
Veterans Health Administration databases, reflecting the clinical care of
more than 330,000 patients. These two studies are reported in the July issue
of the American Journal of Psychiatry (AJP), the official journal of the American Psychiatric Association.

The first study, “Suicide Attempts Among Patients Starting Depression
Treatment with Medications or Psychotherapy,” is presented by Gregory Simon, M.D., M.P.H.,
and James
Savarino, Ph.D., of Group Health Cooperative—a mixed-model prepaid health
plan with approximately 500,000 members in Washington State and Idaho.

Among the 109,256 members treated for depression between 1996 and 2005, suicide
attempts decreased during the first month of treatment and diminished further
in subsequent months. This progressive decline occurred for both patients
taking medication and those receiving psychotherapy. About 60% of
the treatment episodes began with antidepressant
prescriptions and about 40% began with psychotherapy visits.

The second study, involving veterans, is described in “The Relationship
Between Antidepressants and Suicide: Results of Analysis of the Veterans Health
Administration Datasets,” by
Robert Gibbons, Ph.D., Kwan Hur, Ph.D., J. John Mann, M.D., and colleagues
at the University of Illinois at Chicago and the New York State Psychiatric
Institute. The findings are based on 226,866 veterans diagnosed with depression
during 2003-2004. The analysis, in addition to showing a decrease in suicide
attempts once treatment began, also revealed a lower rate of suicide attempts
in depressed veterans who took antidepressants compared to those who did not. Selective
serotonin reuptake inhibitors (SSRIs) were the most commonly prescribed antidepressants,
and the rate of suicide attempts for patients taking SSRIs fell from 221 per 100,000
patients before treatment, to 123 per 100,000 after treatment began. The rate
also fell after the beginning of treatment with medications known as non-serotonergic
and tricyclic antidepressants.

The positive overall outcomes in the two studies were shared by the youngest
patients. The adolescents and young adults studied by Simon and Savarino
made approximately twice as many suicide attempts as the total group, but
they showed a similar decline after beginning treatment. Gibbons et al.
found that all age groups, including 18 to 25 year olds, experienced both
a decline in suicide attempts with treatment and a lower incidence among
depressed veterans receiving SSRIs, compared to those receiving no antidepressant treatment.

The authors point out that large-scale studies do not exclude the possibility
that depression treatment may precipitate suicidal thinking or behavior in vulnerable individuals.

The findings are reviewed in an editorial by David Brent, M.D., of the University
of Pittsburgh. AJP Editor in Chief Robert Freedman, M.D., stated

“ These studies of treatment
in actual clinical practice find a decrease in suicide attempts after treatment,
regardless of whether the treatment is psychotherapy or drug therapy. Patients
and their doctors are concerned because of the FDA’s black-box warning
that antidepressants can cause suicide attempts. The studies in this issue
provide more evidence that this side effect is rare, compared to the overall
decrease
in suicide attempts that occurs when treatment is initiated. Furthermore,
suicide attempts in the first month of treatment occur regardless of whether
the treatment is psychotherapy or drug therapy, which suggests that these
attempts are part of the natural evolution of symptoms in depression itself.”

Both studies were funded by grants from the
National Institute of Mental Health. Additional financial disclosures appear
at the end of each of the reports.

About the American Psychiatric Association
The American Psychiatric Association is a national medical specialty society
whose more than 38,000 physician members specialize in diagnosis, treatment,
prevention and research of mental illnesses including substance use disorders.
Visit the APA at www.psych.org and www.HealthyMinds.org.

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